Abrupt Transition to Remote Learning in Nursing Students During the COVID-19 Pandemic.

BACKGROUND: This scoping review aimed to identify the issues faced by nursing students, including those in undergraduate and graduate programs, during the emergency academic learning transition from face-to-face to remote learning at the outset of the coronavirus disease 2019 (COVID-19) pandemic. METHOD: Five electronic databases were searched for eligible studies, published between January 2020 and May 2023. Studies that focused on remote learning among nursing students during the COVID-19 pandemic were eligible for inclusion. Subsequently, the data were extracted and thematically synthesized. RESULTS: After searching and reviewing the literature, 34 primary and empirical studies were identified. The data synthesis identified six themes, including four weaknesses and two strengths. CONCLUSION: This review demonstrated that nursing students have endeavored to overcome the situation amid the sudden transition in educational modalities and remained committed to their academic progress. We recommend that a new paradigm of nursing education should be prepared for nursing students and faculties. [J Nurs Educ. 2024;63(2):108-115.].

Determinants of the intention to work in aged care: a cross-sectional study to assess gerontological nursing competencies among undergraduate nursing students.

BACKGROUND: There are huge demands for aged-care workers, and undergraduate gerontological nursing education plays a critical role in providing academic and professional training. PURPOSE: To examine relationships of characteristics, aged-care education, and gerontological nursing competencies with the intention to work in aged care. METHODS: An online survey was distributed to undergraduate nursing students between April and June 2022 to gather characteristics, relevant aged-care education, gerontological nursing competencies, and intentions to work in aged care data. Multivariate regression analyses were conducted to identify determinants of the intention to work in aged care. RESULTS: Students (n = 358) who were older (p < 0.001) and who were married (p < 0.001) had higher intentions to work in aged care. "Promoting mental health and psychological well-being", "Providing evidence-based dementia care", and "Enabling access to technology", were also associated with positive intentions. CONCLUSIONS: This study provides evidence on determinants of the intention to work in aged care, particularly gerontological nursing competencies.

Measuring gerontological nursing competencies among aged care nurses: Cultural adaptation and psychometric validation.

BACKGROUND: Existing gerontological nursing competencies include the requisite knowledge and skills required for aged care nursing. What were not previously considered were legal and ethical aspects and access to technology, e-health and social media. OBJECTIVES: This study aimed to validate an Australian gerontological nursing competencies scale and assess the factors associated with for aged care nurses in Taiwan. METHODS: A methodological study design was used to validate the scale with a sample of 369 aged care nurses from aged care settings including nursing homes, long-term care facilities and aged care wards in Taiwan. The cultural adaptation and psychometric validation were evaluated. The content validity, construct validity through exploratory factor analysis and the internal consistency of the scale were assessed. RESULTS: The exploratory factor analysis extracted two levels of gerontological nursing practice, 'essential' and 'enhanced', which accounted for 80.8% of the total variance. The internal consistency, split-half reliability and test-retest reliability were excellent. Aged care nurses with higher levels of education, aged care education as their highest degree and continued education within 6 months, and certified long-term care education had higher gerontological nursing competencies scores than those who did not. CONCLUSIONS: This validated gerontological nursing competencies scale is a reliable and valid tool that can be implemented in future workforce planning, research and postgraduate and undergraduate curriculum and education in Taiwan and other Mandarin-speaking locales. IMPLICATIONS FOR PRACTICE: Using validated gerontological nursing competencies scales to explain different levels of specialist practice is crucial for addressing negative views about aged nursing and explicitly demonstrate the possibilities for career pathways in gerontological nursing.

Antenatal care experiences of uninfected pregnant women during the COVID-19 pandemic: A qualitative systematic review.

BACKGROUND: There is a limited understanding of pregnant women's antenatal care experiences during the COVID-19 pandemic. PURPOSE: To review and synthesize qualitative studies on uninfected pregnant women's antenatal care experiences during the COVID-19 pandemic. METHODS: Five databases were searched for qualitative studies published between January 2020 and January 2023. This study used a thematic synthesis of qualitative evidence and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Furthermore, this review was registered with PROSPERO and a quality appraisal was assessed. RESULTS: Nine published qualitative studies were included in this review. The studies were conducted in eight countries and included 3,709 participants. Five themes were identified: (a) disruptions of normal antenatal care services, (b) feelings of uncertainty, (c) desire for sufficient spousal support, (d) coping strategies, and (e) trust in health care providers. DISCUSSION AND CONCLUSION: The themes can be utilized to reform current interventions for pregnant women by nurse-midwife managers and by health care policymakers to improve current practice and direct new research to prepare for future pandemics.

Transitional care interventions for supporting frail older adults discharged from hospitals: An umbrella review.

Transitional care interventions have been shown to assist frail older adults; however, their true efficacy remains inconclusive. This umbrella review aimed (1) to summarize the components of transitional care interventions in support of frail older adults discharged from hospitals to community-based facilities that may have impacted healthcare outcomes and (2) to synthesize the impacts of these interventions. Systematic reviews published between January 2018 and September 2022 were screened using seven electronic databases. The review protocol followed the Joanna Briggs Institute Reviewers' Manual and was registered in the PROSPERO. Nine relevant systematic reviews were assessed for their methodological quality. Four of the measured primary healthcare outcomes improved as a result of transitional care interventions. In particular, evidence indicates that high-intensity transitional care or transitional care lasting at least one month can improve healthcare outcomes in frail older adults. Additional funding research and practical guidelines are warranted.

Fragmented care and chronic illness patient outcomes: A systematic review.

AIM: This systematic review examined recent studies on fragmented care of patients with chronic illnesses in the United States to examine the association between fragmented care and patient outcomes. DESIGN: Systematic review. METHODS: Studies published from January 1, 2012, to June 1, 2022, were selected from four electronic databases (PubMed, CINAHL, PsycINFO, and Web of Science), following the Cochrane protocols and PRISMA statements. Based on inclusion and exclusion criteria, ten studies that examined associations published between 2015 and 2021 were selected. A methodological assessment was conducted with the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The studies selected for this systematic review were rated as having fair methodological rigor. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42021285379). Because of the heterogeneity of the selected studies' data, a systematic narrative synthesis of the extracted data was conducted. RESULTS: Three common measures for fragmented care and outcomes were synthesized. A synthesis of the studies found significant association between fragmented care and adverse outcomes of chronic illnesses (emergency department visits, utilization of diagnostic tests, and healthcare costs). Despite the heterogeneity of significant findings between fragmented care and patient outcomes, the relationship between these outcomes and fragmented care was significant. This systematic review provides clear evidence of the association between care fragmentation and its adverse effects on individuals with chronic illnesses. However, mixed relationship findings were also reported. CONCLUSION: Given the demands of overcoming fragmented care in healthcare settings in the United States, nurse managers, healthcare leaders, and policymakers should utilize this evidence to reduce fragmented care strategies. It is recommended that nurse researchers and other healthcare practitioners conduct further studies to understand the contexts and mechanisms of fragmented care and develop theoretical frameworks for care fragmentation and chronic illness outcomes.

Critical care nurses' knowledge and attitudes and their perspectives toward promoting advance directives and end-of-life care.

BACKGROUND: End-of-life care can be a difficult and challenging process for critical care nurses in intensive care units (ICUs) due to the care plan shifts from providing life-sustaining measures to end-of-life care. The aims of this study were to assess critical care nurses' perceived knowledge and attitudes toward end-of-life care, as well as their perspectives on promoting advance directives and the associated factors. METHODS: A cross-sectional study was undertaken in an acute major metropolitan medical center in northern Taiwan between February and March 2020, and 250 critical care nurses were invited to participate in the study. Data on demographics, self-perceived knowledge of end-of-life care, attitudes toward end-of-life care, and perspectives of promoting advance directives were collected. A multiple linear regression model with stepwise selection was used to identify factors associated with their perspectives of promoting advance directives. RESULTS: The law related to end-of-life care was rated as the least familiar part of the self-perceived end-of-life care knowledge, while 'I have sufficient knowledge to care for patients who have accepted end-of-life care' was the lowest level of agreement in attitude scores among critical care nurses. Increased levels of perceived knowledge (ß = 0.134; p = 0.045) and attitudes (ß = 0.423; p < 0.001) toward end-of-life care were associated with the perspectives of promoting advance directives. Nurses who worked in cardiac (ß = -0.234; p < 0.001) and respiratory ICUs (ß = -0.135; p = 0.024) had less motivation to promote advance directives (F = 16.943; p < 0.001). CONCLUSION: Given their important contributions to ICU care services, appropriate and meaningful support is required to optimize critical care nurses' involvement in end-of-life care. This study demonstrated a significant impact on perspectives of promoting advance directives of critical care nurse participants. Findings from this study can inform the design of effective nurse support programs to enhance the promotion of advance directives in intensive care settings.

Nurse-Led Telehealth Interventions During COVID-19: A Scoping Review.

Since the outbreak of COVID-19, telehealth expanded rapidly and was adopted as a substitute for in-person patient and nurse visits. However, no studies have mapped nurse-led telehealth interventions during the pandemic. This study aimed to identify and summarize the strengths and weaknesses of nurse-led telehealth interventions for community-dwelling outpatients during the COVID-19 pandemic. This study used a scoping review methodology and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review Extension. Five electronic databases were searched to find studies published in English peer-reviewed publications between January 2020 and February 2022. A total of 490 articles were retrieved, of which 23 empirical studies were selected based on the inclusion/exclusion criteria. Primary studies from nine countries with a variety of research designs were included. Four strengths and three weaknesses of nurse-led telehealth interventions for patients during COVID-19 were identified. For telehealth services to provide effective, efficient, and quality patient care, future research and nursing practice need to overcome the identified weaknesses of current nurse-led telehealth interventions. More rigorous evidence-based research and updated and standardized guidelines for nurses' telehealth services will help improve the quality of patient care. Nurse managers, leaders, and policymakers can use the findings of this scoping review to refine the current telehealth services system.

Gender differences in the association between oral health literacy and oral health-related quality of life in older adults.

BACKGROUND: Poor oral health affects quality of life; oral health literacy studies are increasing as it plays an essential role in promoting oral health. However, little is known regarding the gender differences in oral health literacy and oral health-related quality of life (OHRQoL) among older adults. This study aimed to explore the gender differences in oral health literacy and OHRQoL among community-dwelling older adults in Taiwan. METHODS: A cross-sectional study design with convenience sampling was undertaken to recruit participants at two community service centres. Data were collected using a structured survey consisted of the demographic characteristics, instrumental activities of daily living, nutrition assessment, oral health literacy and OHRQoL. The logistic regression was used to examine the gender differences in the relationship between oral health literacy and OHRQoL. RESULTS: A total of 202 participants completed the survey. Of which 56.4% (n = 114) were female. Logistic regression analyses showed that after controlling for age, instrumental activities of daily living, nutrition, education level, and average monthly income, better oral health literacy was associated with better oral health quality of life (p = 0.006) in men. CONCLUSIONS: The relationship between oral health literacy and OHRQoL was only significant for men. No significant relationship between women's oral health literacy and their OHRQoL. However, good OHRQoL is an integral part of overall health, but it is affected by differences in oral health and the accessibility of healthcare services. We suggest that gender-specific oral health literacy education should be offered through community health-education programs.

The Experience of Chronic Illness Transitional Care: A Qualitative Systematic Review.

This is a qualitative systematic review of recent qualitative studies of the experiences and perceptions of both individuals with chronic illness(es) and their caregivers regarding hospital-to-home transitions. Thematic synthesis was used to identify common themes from seven qualitative studies published from 2012 to 2021 and extracted from four electronic databases. This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Quality appraisal was assessed and adequate methodological rigor was determined. A total of three barriers to transitional care (communication with multiple healthcare providers, self-management, and psychological stress) and two facilitators of transitional care (family caregiver support and nurse-provided patient-centered care) were identified. These findings can be used by nursing research and healthcare managers to reform transitional care practices for chronic illnesses and caregivers.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses.

This scoping review aimed to examine telehealth-assisted case management for chronic illnesses and assess its overall impact on health care delivery. Guided by the PRISMA statement, this review included 36 empirical studies published between 2011 and 2020. This study identified three weaknesses and four strengths of telehealth-assisted case management. While the weaknesses were negative feelings about telehealth, challenges faced by patients in learning and using telehealth devices, and increased workload for case managers, the strengths included efficient and timely care, increased access to health care services, support for patients' satisfaction, and cost savings. Future research can be designed and conducted for overcoming the weaknesses of telehealth-assisted case management. Additionally, the strengths identified by this review need to be translated from research into case management practice for chronic illness care. This review not only describes the value of such care strategy, but also provides implications for future nursing practice and research.

Effectiveness of transitional care interventions for chronic illnesses: A systematic review of reviews.

AIM: This systematic review of reviews aims to critically evaluate and synthesize findings from recent systematic reviews to analyze the effectiveness of transitional care interventions in the management of adult patients with chronic illnesses. BACKGROUND: Transitional care interventions have been provided to patients with chronic illnesses for reducing fragmented care and hospital readmissions after discharge. However, the effectiveness of the interventions on outcomes other than hospital readmissions is still unclear. REVIEW METHODS: This study used the systematic review of systematic reviews methodology. From five electronic databases, systematic reviews published between January 2011 and December 2020 and those that met the inclusion and exclusion criteria were searched and screened to retrieve recent evidence. RESULTS: Eight systematic reviews that met the inclusion criteria and had high methodological quality were included. All included transitional care interventions aimed to reduce fragmented care and hospital admissions and improve health care outcomes in chronically ill patients. On summarizing and synthesizing the data, four common outcomes-hospital readmissions, quality of life, mortality, and health care cost savings-were retrieved. There was evidence regarding the effectiveness of transitional care on health care cost savings; however, other outcomes showed mixed results. CONCLUSIONS: Transitional care interventions are effective for patients with chronic illnesses. It is important to have standardized outcome measures; therefore, it is recommended to fund research and reimbursement of transitional care practices. The findings and implications of this review are important to nurse managers, health care practitioners, researchers, and policymakers.

Culturally tailored interventions for ethnic minorities: A scoping review.

AIM: This scoping review identifies strengths and weakness of culturally tailored interventions for ethnic minorities' care in the United States. It reviews recently published studies to improve understanding of these interventions for future research and practice. DESIGN: Scoping review. METHODS: By searching five electronic databases-CINAHL, PubMed, Ovid, Scopus and Web of Science, this review located 58 empirical studies published between 2015-2019. This review was guided by the PRISMA statements. RESULTS: The review identified four weaknesses and five strengths of culturally tailored interventions. Weaknesses included unclear guidelines, low attention and retention rates, failure to measure processes and inadequate training for healthcare providers. The intervention strengths were culturally respectful and patient-centred care, healthy lifestyle promotion, increased family and community supports, technology use for efficient and timely care and increased knowledge of disease by participants.

Nurses' barriers to caring for patients with COVID-19: a qualitative systematic review.

AIM: The aim of this qualitative systematic review is to identify and synthesize qualitative studies of frontline nurses' experiences and challenges when caring for patients with COVID-19 in hospitals. BACKGROUND: This review is the first qualitative systematic review of nurses' experiences since the beginning of the COVID-19 pandemic in 2020. Understanding nurses' experiences with COVID-19 is important because nurses are among the most vital of healthcare workers. METHODS: This study used a qualitative systematic review methodology with thematic synthesis to analyse the included studies. Five databases (CINAHL, PubMed, Ovid, Web of Science, and PsycINFO) were searched from January to mid-August 2020, and 25 abstracts were screened. Based on inclusion criteria, this qualitative systematic review included nine studies. RESULTS: Five themes were identified as barriers to COVID-19 care by 133 hospital-based nurses: limited information about COVID-19, unpredictable tasks and challenging practices, insufficient support, concerns about family, and emotional and psychological stress. CONCLUSIONS: The five barriers identified in this review should be overcome to improve nurses' experiences and, in turn, the quality of care patients with COVID-19 receive. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings from this review can be used to reform current healthcare and hospital-support systems for populations with COVID-19. They can also be used to point towards areas of research interested in improving frontline nursing. Finally, nursing leaders, healthcare policymakers and governments should use these findings to better support the nursing workforce in the current or a future pandemic.

Experience of Culturally-Tailored Diabetes Interventions for Ethnic Minorities: A Qualitative Systematic Review.

This qualitative systematic review synthesizes recent qualitative studies of culturally tailored interventions to better understand the experiences that individuals who are members of ethnic minorities have when undergoing type 2 diabetes treatment in the United States. Such interventions have been shown to be effective among ethnic minority populations; however, no qualitative synthesis has reported on recent findings from studies of these interventions. This systematic review identified seven relevant qualitative studies from five electronic databases-CINAHL, PsycINFO, PubMed, Ovid, and Web of Science-published from 2009 to 2019, and used a thematic synthesis review methodology. Methodological rigor was assessed for an appraisal of study quality. Five themes were identified as experiences of culturally tailored diabetes interventions: culturally appropriate healthy lifestyle behaviors, knowledge about diabetes care, emotional supports, access to the healthcare system, and family involvement. The findings of this review can be utilized as resources for improving diabetes care for ethnic minorities.

Understanding Nurse-led Case Management in Patients with Chronic Illnesses: A Realist Review.

This realist review aims, with evidence from recent studies, to understand both how nurse-led case management interventions are implemented in the management of chronic illnesses, and in what circumstances these interventions are successful. The review followed the realist review methodology. From four electronic databases, twenty empirical and primary nurse-led case management intervention studies published between January 2011 and February 2020 were included. For each study, causality was explored, and findings were integrated. Three contexts, five mechanisms, and three major outcomes were found, and several context-mechanism-outcome strings were identified. Further analysis and synthesis of the studies showed that when duration of intervention, service delivery mode, and types of services are appropriate, as well as number of services with patients considering care is provided, case managment interventions change outcomes for patients with chronic illnesses. Finally, an explanatory conceptual framework based on the review results was developed to guide nurse managers and researchers.

Effectiveness of Culturally Tailored Interventions for Chronic Illnesses among Ethnic Minorities.

Culturally tailored interventions have been applied to provide benefits to ethnic minorities' care; however, the effectiveness of these interventions for chronic conditions is mixed. This systematic review of systematic reviews critically evaluates recent evidence of the effects that culturally tailored interventions have on health care outcomes among ethnic minorities with chronic conditions. It synthesizes results of eight English-language systematic reviews published between 2010 and 2018 and identifies four health care outcomes common to the reviews: disease knowledge, objective clinical outcomes, satisfaction, and access. Our findings suggest that culturally tailored interventions can contribute to the improvement of ethnic minorities' health care outcomes and especially improve patients' satisfaction with care. However, results overall are mixed. Further studies to better understand the value of culturally tailored interventions for ethnic minorities' care are needed.

Validation and evaluation of the Mandarin version of the oral health literacy adult questionnaire in Taiwan.

OBJECTIVES: This study aimed to translate the Oral Health Literacy Adult Questionnaire into a Mandarin version (MOHL-AQ) and to examine its psychometric properties. METHODS: A methodological research using psychometric testing and evaluation of a translated instrument. A convenience sample of 402 participants from northern Taiwan were recruited for the validation of the MOHL-AQ. Internal consistency reliability, split-half reliability, inter-rater reliability, face validity, content validity, and construct validity were evaluated. RESULTS: The value of internal consistency and split-half reliability of the MOHL-AQ were 0.77 and 0.78, respectively. Content validity reported a high content validity index (CVI = 95%). Exploratory factor analysis (EFA) and parallel analysis (PA) were used to determine a unidimensional model and confirmatory factor analysis (CFA) was employed to confirm the model. The indices of good fit model were achieved at GFI = 0.93, AGFI = 0.92, RMSEA = 0.04, CFI = 0.90, PGFI = 0.73, χ2 /df = 1.86 (p < .001). Most of the item-total correlations indicated adequate and acceptable convergent validity (r > .30). CONCLUSION: MOHL-AQ demonstrates adequate psychometric properties for measuring the oral health literacy in Mandarin-speaking population. Public health nurses can use MOHL-AQ to assess oral health literacy in the community settings and further screen potential population with inadequate oral health literacy.

Nurses' Barriers to Care of Ethnic Minorities: A Qualitative Systematic Review.

Several studies have reported nurses' challenges when caring for ethnic minority patients from diverse cultures and who have language differences. This qualitative systematic review aims to identify and describe barriers to nursing practices and to understand the common perceptions that nurses in Western countries have when providing culturally competent care to ethnic minority patients. In this review, eight qualitative, peer-reviewed studies published from 2010 to 2018 are synthesized to identify barriers to nurses' practice with ethnic minority patients. Qualitative systematic review protocols with thematic synthesis as a methodology were employed, and five common themes were identified: communication issues; unclear, missing, or culturally inappropriate care information and resources; insufficient cultural training and education; challenging therapeutic relationships with patients; and concern about quality of care. These results suggest that future studies should explore the cost-effectiveness of cultural competency training.

Predictors of Emergency Department Use Among Community-Dwelling Older Adults.

A cross-sectional research study was conducted to explore factors associated with and predictors of emergency department (ED) use among community-dwelling older adults. Data were collected using questionnaires regarding demographic characteristics, health literacy, comprehensive assessment instruments, and ED use. Age, fall frequency, number of diseases, number of medications, health literacy, nutritional status, cognitive function, and activities of daily living were associated with ED use. Age (adjusted odds ratio [aOR] = 1.04, 95% confidence interval [CI] [1.00, 1.07]), health literacy (aOR = 0.89, 95% CI [0.79, 0.99]), number of diseases (aOR = 1.34, 95% CI [1.01, 1.78]), and cognitive function (aOR = 0.73, 95% CI [0.55, 0.96]) were significant predictors of ED use. Health care professionals, researchers, and education providers need to assess patients' health literacy, number of diseases, and cognitive function and take approaches to improve health literacy in older adults to maintain their health as well as reduce ED use. [Journal of Gerontological Nursing, 45(5), 31-38.].